| NPI | 1346302338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9104600) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601004826) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2021-10-21 |